Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort

Abstract

Objective: This study examined longitudinal associations between attention-deficit/hyperactivity disorder (ADHD) symptoms and social isolation across childhood. The study tested the direction of this association across time, while accounting for preexisting characteristics, and assessed whether this association varied by ADHD presentation, informant, sex, and socioeconomic status.

Method: Participants included 2,232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. ADHD symptoms and social isolation were measured at ages 5, 7, 10, and 12. Random-intercept cross-lagged panel models were used to assess the directionality of the association across childhood.

Results: Children with increased ADHD symptoms were consistently at increased risk of becoming socially isolated later in childhood, over and above stable characteristics (β = .05-.08). These longitudinal associations were not bidirectional; isolated children were not at risk of worsening ADHD symptoms later on. Children with hyperactive ADHD presentation were more likely to become isolated, compared with inattentive presentation. This was evident in the school setting, as observed by teachers, but not by mothers at home.

Conclusion: The study findings highlight the importance of enhancing peer social support and inclusion for children with ADHD, particularly in school settings. This study adds explanatory value beyond traditional longitudinal methods, as the results represent how individual children change over time, relative to their own preexisting characteristics.

Diversity & inclusion statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Keywords: ADHD; bidirectional; informants; longitudinal; social isolation.

Figure 1

Longitudinal Association Between Social Isolation and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms Across Ages 5, 7, 10, and 12 Using Cross-Lagged Panel Model (A) and Random-Intercept Cross-Lagged Panel Model (B) Note:Nonsignificant regression paths are indicated by dashed one-headed arrows. Significant regression paths are indicated by solid one-headed arrows. Correlation paths are indicated by double-headed arrows. Subscript numbers indicate time point of assessment. Combined mother and teacher scores were used at all time points. Within-person level of the random-intercept cross-lagged panel model (B) is indicated in pink, and between-person is indicated in blue. Cross-lag paths were constrained to be equal across time. AD = measured ADHD symptom sum score; BAD = between-person level ADHD represented by a random intercept; BSI = between-person social isolation represented by a random intercept; SI = measured social isolation sum score; WSI = within-person level factor of social isolation; WAD = within-person level factor of ADHD. ∗p < .05; ∗∗p < .01; ∗∗∗p < .001.

Figure 2

Longitudinal Associations With Social Isolation According to Different Attention-Deficit/Hyperactivity Disorder Presentations Note:(A) The random-intercept cross-lagged panel model representing the longitudinal association between social isolation and hyperactivity across ages 5, 7, 10, and 12. (B) The random-intercept cross-lagged panel model representing the longitudinal association between social isolation and inattention across ages 5, 7, 10, and 12. Nonsignificant regression paths are indicated by dashed one-headed arrows. Significant regression paths are indicated by solid one-headed arrows. Correlation paths are indicated by double-headed arrows. Subscript numbers indicate time point of assessment. Combined mother and teacher scores were used at all time points. Both models have cross-lag paths constrained to be equal across time. BHY = between-person level hyperactivity represented by a random intercept; BIN = between-person level inattention represented by a random intercept; BSI = between-person social isolation represented by a random intercept; HY = measured hyperactivity symptom sum score; IN = measured inattention symptom sum score; SI = measured social isolation sum score; WHY = within-person level factor of hyperactivity; WIN = within-person level factor of inattention; WSI = within-person level factor of social isolation. ∗p < .05; ∗∗p < .01; ∗∗∗p < .001.